Provider Demographics
NPI:1710013750
Name:LAMOTTE, DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LAMOTTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3560
Mailing Address - Country:US
Mailing Address - Phone:831-662-9562
Mailing Address - Fax:
Practice Address - Street 1:1156 HIGH ST.
Practice Address - Street 2:UNIVERISTY OF CALIFORNIA SANTA CR UZ STUDENT HEALTH
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064
Practice Address - Country:US
Practice Address - Phone:831-459-1407
Practice Address - Fax:831-459-3564
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist